Health Care Firms Accused Of Bilking Insurers

An intricate network of South Florida health care companies allegedly bilked insurers of more than $410,000 by billing them for heart-monitoring services never performed on patients.

More than 300 patients also participated in the scheme, accepting money for providing their insurance billing information to the companies involved, investigators with the Florida insurance commissioner and the statewide prosecutor's office said Friday.

Racketeering charges have been filed against a Fort Lauderdale woman, Maria Prieto, 43, who operated Pacificare Case Management Inc., where most of the proceeds of the scheme were funneled, investigators said. Her husband, Carlos Manuel Prieto, 43, and Gabriel O. Sanchez, who allegedly posed as a physician, have also been charged. All three have fled South Florida to avoid prosecution, according to investigators.

So far, seven people have been arrested and four others are expected to surrender shortly. No patients have been charged.

The services billed were for use of personal heart monitors worn 24 hours a day by patients to detect episodes of rapid heartbeat or other irregularities. The monitors can be hooked up to telephones to send in results.

The network allegedly included five heart-monitoring service companies, three other medical companies, a medical management company and an unlicensed physician, Sanchez, who worked in a busy Miami clinic, Physicians Association. Dr. Fausto Castillo, who owned the clinic, told investigators he never suspected that Sanchez did not have a medical license when he hired him more than two years ago.

Sanchez is charged with racketeering and grand theft. It was Sanchez who allegedly persuaded patients to participate in the scheme by offering them a percentage of the amount insurance companies paid for the heart-monitoring service they never got.

Also charged were Maria Prieto's brother and sister-in-law, Noel and Frances O. Gonzalez, of Pembroke Pines. Frances Gonzalez, who owned Accurate Express Billing Inc. in southwest Miami, has been charged with conspiracy to commit racketeering for allegedly assisting in the fraudulent billing. Her husband is charged with conspiracy to commit racketeering and money laundering. He owned Nationwide Services Inc., one of three companies suspected of laundering proceeds from the scheme.

Dan Cerione, law enforcement officer with the Department of Insurance Division of Insurance Fraud in Plantation, said insurers became suspicious of some of the claims and contacted patients to see if they had received the services. Many of the patients were young, with no history of heart problems.

Nancy McVicar can be reached at nmcvicar@sun-sentinel.com or 954-356-4593